Florida Is Proposing Changes to the ALF DNRO Rule — Here’s Exactly What Would Change
Florida assisted living facility owners and administrators need to be aware of a proposed change to Rule 59A-36.009, the rule that currently addresses Do Not Resuscitate Orders (DNROs) in ALFs.
Before we get into the changes, let me make one thing very clear:
This is a PROPOSED rule change. It is NOT effective yet.
The current version of Rule 59A-36.009 remains in effect.
However, AHCA published a proposed amendment on June 17, 2026, and if it is ultimately adopted, there are several changes ALF owners and administrators should understand.
The good news is that this is not a complete rewrite of Florida’s DNRO requirements.
Much of the existing rule would remain unchanged.
The biggest changes involve advance directives, the information facilities provide at admission, and updated DNRO documentation.
Here is what would actually change.
1. The Rule Would Expand Beyond Just DNROs
Currently, Rule 59A-36.009 is titled:
“Do Not Resuscitate Orders (DNROs)”
Under the proposed amendment, the rule would be expanded to specifically address advance directives as well.
That is important because advance directives cover a much broader area than simply whether someone wants CPR performed.
The proposed language would require facilities to establish written policies regarding a resident’s rights concerning advance directives, in addition to the existing requirements surrounding DNROs.
What this could mean for your facility:
If your current policy only explains how your facility handles DNROs, you may eventually need to update that policy to more clearly address residents’ rights regarding advance directives.
This is one of the first documents I would review if the proposed rule becomes final.
2. The Admission Information Requirement Would Change
The current rule specifically requires facilities to provide residents or their representatives with:
Form SCHS-4-2006, “Health Care Advance Directives – The Patient’s Right to Decide,”
or another substantially similar document containing the advance-directive information required under Chapter 765, Florida Statutes.
That’s an old document.
Under the proposed rule, that specific 2006 document would no longer be the focus.
Instead, the facility would provide the resident or resident’s representative with a written or electronic copy of health-care advance-directive information pursuant to Chapter 765, Florida Statutes.
Why this matters:
If your facility has been using the same admission packet for years, this is something you should pay attention to.
Once the rule becomes effective, facilities should review their admission packets and make sure the advance-directive information being provided complies with the final version of the rule.
This is exactly the type of small documentation change that can easily get overlooked.
3. The DNRO Form Referenced in the Rule Would Be Updated
This may be one of the easiest changes for facilities to identify.
The current rule incorporates an older version of the Florida Department of Health’s DNRO form.
The proposed amendment updates the incorporated material to the newer DH Form 1896 (02/2024).
What should ALFs eventually check?
Look at the DNRO forms currently being maintained in resident records.
Look at any blank DNRO forms your facility keeps available.
Look at your admission paperwork.
And make sure you aren’t continuing to distribute or rely upon an outdated version once the new requirement becomes effective.
Again, don’t replace documents simply because the rule has been proposed.
Wait until we have a final rule and effective date, and then make sure you’re using what the final regulation actually requires.
4. Old References and Information Would Be Modernized
Another part of the proposal cleans up outdated references within the existing regulation.
Some of the materials and resources referenced in the current rule are many years old.
AHCA’s proposed amendment updates those references and modernizes how facilities can obtain and provide advance-directive information.
This may sound like a minor administrative change, but it matters.
ALFs often continue using the same forms and admission packets for years.
Something gets copied.
Then copied again.
Then somebody scans the old packet.
Five years later, nobody knows where the original document came from.
When regulations update incorporated forms or documents, administrators should use that as a reminder to review the entire admission packet, not simply the one page that changed.
What Is NOT Changing?
This is equally important.
Based on the proposed language, AHCA is not completely rewriting the operational requirements surrounding DNROs.
Several existing portions of Rule 59A-36.009 are specifically identified as having “No change.”
So I would not characterize this proposal as Florida creating an entirely new DNRO process for assisted living facilities.
A better way to describe it is:
AHCA is expanding and modernizing the existing DNRO regulation, particularly as it relates to advance directives and the information and forms provided to residents.
That’s an important distinction.
What Should ALF Owners Do Right Now?
Right now?
Don’t change anything solely because of this proposal.
The proposed amendment is not yet effective.
Continue following the currently effective version of Rule 59A-36.009.
But I would start identifying where these documents live in your facility.
Pull out your:
- DNRO policy and procedures
- Advance-directive policy
- Admission packet
- Advance-directive information provided at admission
- Blank DNRO forms
- Current resident DNRO documentation
You don’t necessarily need to change them today.
Just know where they are.
That way, if the proposed amendment becomes final, you aren’t scrambling to figure out what needs to be updated.
The Bigger Compliance Lesson
There is also a bigger lesson here for ALF owners.
Regulatory compliance isn’t just about knowing that a regulation changed.
You have to ask:
“Where does this regulation live inside my facility?”
If AHCA changes an admission requirement, what document needs to change?
If AHCA changes an incorporated form, where are we keeping copies of the old form?
If AHCA changes a policy requirement, who updates the policy?
If a new requirement becomes effective, who makes sure the staff actually know about it?
That is how you build a compliance system.
ALF BOSS Bottom Line
AHCA’s proposed changes to Rule 59A-36.009 appear to focus on four main areas:
- Expanding the rule to more specifically address residents’ rights concerning advance directives.
- Updating what advance-directive information facilities provide during admission.
- Updating the DNRO form incorporated into the rule to the newer DH Form 1896.
- Cleaning up outdated forms, references, and information contained in the existing regulation.
Much of the actual DNRO process would remain unchanged.
And most importantly:
None of these proposed changes are effective yet.
The current Rule 59A-36.009 remains the regulation facilities must follow today.
But this is one proposed rule I would definitely keep on your radar.
If it becomes final, I’ll break down the final language and show you exactly what needs to be changed in your policies, admission packet, forms, and facility systems so you can stay ahead of it.